June 12, 2014

Doubting Euthanasia

By Hendrik van der Breggen
The Carillon, June 12, 2014

Doubting Euthanasia

Is it wise to legalize euthanasia (a.k.a. physician-assisted suicide/ doctor-assisted death)? I doubt it, for five reasons.

1. The popular argument for euthanasia hinges on a false dichotomy: euthanasia or painful death. Significantly, there's a third option: palliative care.

Doris Barwich, M.D., President of Canadian Association of Palliative Care Physicians: "Pain is rarely the reason patients ask for hastened death—it more often comes out of a desire to control the circumstances surrounding death. Fortunately, we can assure our patients that with Palliative Care tools and resources, pain and other distressing symptoms can usually be controlled and support provided to ensure comfort and quality of life."

2. Instead of euthanasia for the (rare) difficult cases, there is palliative sedation.

Journal of the American Medical Association: "Palliative sedation is the use of sedative medications to relieve extreme suffering by making the patient unaware and unconscious (as in a deep sleep) while the disease takes its course, eventually leading to death. The sedative medication is gradually increased until the patient is comfortable and able to relax. Palliative sedation is not intended to cause death or shorten life."

If, foreseeably, palliative sedation hastens death, it needn't be judged unethical. According to ethicist Margaret Somerville, just as death isn't the intended effect of high risk surgery (needed to relieve pain), and so such surgery isn't immoral if death occurs, so too if death isn't the intended effect of high risk pain management, yet death occurs, then such pain management isn't immoral either.

There's an important moral difference between engaging in a procedure with intent to kill (euthanasia) rather than not (palliative sedation). Euthanasia takes the lower moral ground.

3. Allowing terminally ill patients to die from their illness via termination of life support by withdrawing/ withholding extraordinary, burdensome, or medically useless treatment is already a legal and ethical part of palliative care—and doesn't require euthanasia.

Ethicist Scott Rae: "Physicians need not always 'do everything' to stave off death, especially when it involves no more than simply delaying an inevitable death…. Choices about CPR, respirators, and intravenous procedures in the last weeks of life should not be viewed as choices for death."

Euthanasia isn't needed, in other words.

4. Euthanasia imposes a terrible burden on the vulnerable. If life is no longer society's default position, then the most vulnerable members of our society—the elderly, terminally ill, disabled—must justify their continued existence.

This is just plain nasty.
5. According to philosopher Paul Chamberlain, a logical-legal slippery slope looms large.

Consider the notion of patient autonomy and the fact that reasons for one action sometimes also justify unintended actions.

In the context of legalized euthanasia, patient autonomy becomes understood in terms of the following fundamental principle: the sufferer has the right to doctor-assisted death to end his/her suffering.

Significantly, accepting euthanasia as a legal right on the basis of this fundamental principle opens up and justifies many other situations in which persons suffer and request death. These situations include the non-terminally ill, the elderly, the disabled, persons with chronic back pain, the depressed teenager, etc.

Trust legislative safeguards for protection? Good luck. Aside from abuse (one third of Belgium's euthanasia deaths were illegal and lacked patient consent), safeguards fail because courts will do what courts do—promote consistency. Consistency demands that all of the above-mentioned persons, if suffering, and if desiring death (and if represented by a smart lawyer), can be reasonably seen to have the right to death as well.

After all, at the core of these other situations is a sufferer who requests doctor-assisted death, rendering situational differences incidental.

Legalizing euthanasia, then, puts us on a non-fallacious slippery slope that embraces death as a solution.

But medical, social, and psychological problems require medical, social, and psychological solutions—not killing.

Surely, legalizing euthanasia is not wise.

(Hendrik van der Breggen, PhD, is associate professor of philosophy at Providence University CollegeThe views in this column do not always reflect the views of Providence.)

P.S. For further reading on euthanasia/ physician-assisted suicide, see the following APOLOGIA columns:
P.P.S. See too Dutch ethicist Theo Boer's views on the recent euthanasia experience of The Netherlands:


poetreehugger said...

1. It is possible this is not always the case. There seem to be cases where the pain could not be (or was not) managed well. Also, for terminal cases of more mental torment than physical, how is that kind of pain to be assessed, or treated?
2. Some of my concern in my first paragraph is addressed here in your second point. But is anaesthesia to the point of permanent unconsciousness of benefit to the patient? I can see positive and negative arguments about this.
3. This is a valid point, but how typical is the situation "terminally ill and on life support" of those people wrestling with this issue? Don't most people wrestle with the ending life issue at a point prior to this more clear cut stage?
I agree the problems in 4. are nasty.
5. It is all complex and disturbing, and there is the real problem of abuse. It seems that to protect the vulnerable from those who would take their life unjustly with the untrue pretense of "ending their suffering", we are pitted in some way against the extreme terminal unhelpable case where there is a desire that "the sufferer has the right to doctor-assisted death to end his/her suffering". And it would be difficult to decide where or when that extreme point is reached, as opposed to the "sufferer who requests doctor-assisted death", and may be treatable.

Have you read this article? http://divinity.uchicago.edu/sightings/do-we-have-duty-live-—-heike-springhart
This is from the Martin Marty Center's publication, Sightings, an article called Do We Have a Duty to Live? By Heike Springhart. "From a theological perspective, Küng’s statements are challenging because he argues out of his deeply-held Christian faith. He is convinced that God is a merciful God who does not enjoy people living in a hell of pain. In asserting that life is a gift from God, he starts from the same position as those who argue against euthanasia. But he insists that we are allowed to return God’s gift. In other words, we have no duty to live."
I find the whole issue almost overwhelmingly difficult, and can sympathize with both sides of the argument, which is not much help to me in defining a position for myself.

Hendrik van der Breggen said...

Hello Poetreehugger,

Thanks for your comment—it's good to hear from you. I have read the article by Heike Springhart, and I have read some earlier discussions of Hans Küng’s pro-euthanasia view.

Truly, I can sympathize with the desire for euthanasia and I can sympathize with Küng’s desire to die at home with dignity, without "becom[ing] a shadow of himself." And I would agree that we "have no duty to live" in the sense that there is a season/ time to die, but I would quickly add that this season/ time occurs in Canada's euthanasia discussion—i.e., in the context of terminal illness—when medical measures are doing no more than prolonging an inevitable death by a disease taking its natural course (even though there may still be some unclarity in such circumstances). And I would like control over the circumstances of my death.

But I also agree strongly with Heike Springhart's claim that "we must weigh the person's individual circumstances and the social dimensions of the debate" (Springhart's italics). In other words, we must recognize that, as important as our individual choices are (especially to us), they do not occur in a social vacuum (our choices often impact others). As I've written in a previous column, we do not have absolute freedom. My freedom to shout "Fire!" in a crowded theatre when there is no fire, and when such shouting will cause a stampede to the exits (and thus cause injury to others), is not justified. The individual's choice for euthanasia, then, must be balanced against the broader consequences of that choice, especially if the choice involves a public policy change.

Enter the pros and the cons of euthanasia/ physician-assisted suicide. Even though not every situation will be clear—there will no doubt be some difficult, agonizing cases—I think that, overall, the cons outweigh the pros. (This is not to say that the pros cease to exist; it's merely to say that it looks to me that the cons count more.)

(Continued below.)

Hendrik van der Breggen said...

Here's a brief review of the pros and cons of euthanasia/ physician-assisted suicide (for ending a terminal illness sooner rather than later):

Pro: I choose and control my dying process by having someone kill me.

Pro: I lessen my pain, suffering, and loss of dignity by having someone kill me.

Con: Palliative care (when done well) also allows me to lessen my pain, suffering, and loss of dignity, i.e., it allows me not to have to live in what Küng calls "a hell of pain." And palliative care doesn't require that someone else kills me.

Con: I already have control over whether I should have extraordinary, burdensome, or useless treatment, and I can let my wishes be known in advance about palliative sedation (this can be done months or years in advance). And this doesn't require that someone else kills me. (The benefit of palliative sedation is that it relieves suffering and lets the terminal disease take its course instead of requiring that a doctor actively kills the patient.)

Con: Euthanasia challenges/ devalues the very life-affirming assumptions of human civilization that respects human life. Euthanasia takes us a step away from a general moral principle that undergirds our civilization: i.e., medical, social, and psychological problems require medical, social, and psychological solutions—not killing.

Con (related to the previous con): With the embrace of euthanasia, life is no longer society's default position, which is to impose a terrible burden on the most vulnerable members of our society. Not just the terminally ill but also the elderly and the disabled must begin to think about justifying their continued existence. I wrote in my above column that this is just plain nasty. Actually, I think it's worse: it's to find someone who's down—and kick them in the teeth.

Con: Euthanasia risks a dangerous slippery slope. There is historical evidence for this. Witness Germany's history in the decade prior to and in the years during World War II, and witness Belgium's and Netherlands' more recent abuses of euthanasia. Also, there is a logical argument that points to this. Witness the non-fallacious logic of the slippery slope argument that lurks in the background of justifications for physician-assisted suicide. (For more on this see the link to my column "Physician-assisted suicide is a slippery slope"; or, better, see Paul Chamberlain's book Final Wishes.)

In conclusion, I think that instead of promoting euthanasia/ physician-assisted suicide, more resources should go into palliative care. Not to prolong life frantically and needlessly, but to improve the quality of life for the dying.

I hope the above is helpful.

P.S. Have you read my article for Focus magazine (a publication of the Christian Medical and Dental Society)? I set out various biblical as well as secular reasons for casting doubt onto the wisdom of suicide and euthanasia. See pages 8-13:"The Image of God: Why Life is Worth Defending Against Physician-Assisted Suicide".

Hendrik van der Breggen said...

For further reading on euthanasia and Quebec's bill 52, see Margaret Somerville's article in the Montreal Gazette: "Disturbing questions remain about Bill 52's impact".

Hendrik van der Breggen said...

Winnipeg Free Press has published a slightly revised version of my column here: "Euthanasia holds nasty consequences".

poetreehugger said...

Thank you for all the links and resources. Ttis is an issue I don't think I can find a complete answer for, but it seems to be wise to look at as many angles as possible.

Hendrik van der Breggen said...

Here is a good article from Oxford Students for Life: Who could possibly be against assisted suicide? Well, all of these people...

poetreehugger said...

Those are clear and believable statements against assisted suicide, easily sympathized with. A statement like "If you’re demented, you’re wasting people’s lives" makes me shudder and feels very wrong.
My problem is I feel sympathy also for those cases, possibly as emotionally powerful, where people are in such pain, whether physically or mentally, that they cannot face going on. I sympathize, I say, but cannot see my way clear to a black and white answer to the dilemma of unbearable pain. Of course, I believe we should be able to treat the pain, and I wish we always could. That problem, of the existence of such pain, is one that especially Christians sometimes have trouble facing, whether from the viewpoint of their prosperity religion, or from fear of what it does to their faith in a beneficent constantly caring God, or for whatever reason.
Perhaps this is just a starting point for me, this grappling with the "wrongness" of assisted suicide versus facing head on the fact that some people suffer really awful pain.
Thanks for the conversation.